China sells a lot of medicine online. Not in a grey market, but inside a licensing system that has been tightened almost every year since 2005, when the first online drug sales licences were issued. In 2008 only ten shops were allowed to sell drugs on the internet. Today the online pharmacy channel is worth tens of billions of yuan a year, and the rules that govern it changed again in May 2026.
That is the part most foreign companies get wrong. They look at the market size, not at the licence table. Then they discover that the product they wanted to sell cannot legally be listed, or can be listed only through a channel they had not planned for.
I am Olivier Verot, founder of GMA. I have been based in Shanghai since 2012 and my teams have run e-commerce and search projects for OTC, dietary supplement and medical device brands entering China, which means dealing with the NMPA filing calendar and with platform compliance reviews, not just with ad budgets. Nothing below is legal or medical advice: on a regulated product you need licensed Chinese counsel, and I say clearly when a point is not verifiable from public sources.
How big the online pharmacy channel actually is
Chinese industry data providers put the B2C online pharmacy market at around 96.5 billion yuan in 2025, up from 37.8 billion yuan in 2021. That is roughly 26% compound annual growth over four years, close to the pace the channel has held for a decade. The category mix has moved too: chemical drugs took 68.8% of online pharmacy sales in 2025, traditional Chinese medicine dropped to 27.0% from 35.7%, and biologics jumped from 1.1% to 4.2%. Anti-infection drugs grew fastest, at roughly 67% a year, reaching about 11.9 billion yuan. Source: 摩熵医药 2025 online pharmacy market analysis.
Be careful with these numbers. When the regulator published its new rules in May 2026, Chinese press quoted the online drug retail market at “over 80 billion yuan” for 2025. The gap with 96.5 billion is a definition problem, not an error: some counts include only drugs, others include health products sold by the same shops, and instant-delivery orders are sometimes counted separately.
The user base is not in doubt. CNNIC counted 418 million internet healthcare users in China at the end of 2024, or 37.7% of all netizens (CNNIC 55th statistical report). Online consultation, appointment booking and drug purchase are now ordinary behaviour, not early adopter behaviour.
Why Chinese consumers moved to buying medicine online
Health spending in China is high and consumers know it. Chinese buyers are careful about what they put in their body, and food safety scandals over the years have left a durable distrust of unfamiliar supply chains. Air quality and chronic stress do the rest. Health is not a soft topic in China, it is a budget line.
The generational split matters more than the income split. The older generation saves for its children and spends little on itself. People born after 1990 spend on their own body without guilt, and often buy for their parents on top. That second flow, adult children buying medicine and supplements for parents in another city, is one of the strongest repeat-purchase behaviours on Chinese health platforms.
Three structural reasons explain the shift online:
- The domestic distribution chain has many layers, so shelf prices were high. Selling on a platform removes intermediaries and makes price and origin information visible side by side.
- Information now comes before the purchase. People read, compare, ask in group chats, then buy. For anyone who dislikes being sold to by a counter pharmacist, the online route is simply more comfortable.
- Delivery. In tier 1 and tier 2 cities, a drugstore order arrives in about 30 minutes, at 2 in the morning if needed. Convenience beat the pharmacy on the corner.
Add to this that Chinese consumers often prefer imported health products, and that these are poorly distributed in physical retail outside the big cities. Online is where they are found. Demand for vitamins and dietary supplements follows the same logic.
The rules: what can actually be sold online, and by whom
This is the section to read twice. “Selling medicine online in China” is not one activity, it is four, with different licences.
| Product type | Can it be sold online to consumers | What is required | Practical limit for a foreign brand |
|---|---|---|---|
| OTC drugs | Yes | Seller holds a drug retail licence and files for online drug sales; platform must verify the seller | Product must be registered with the NMPA and imported through a licensed Chinese entity. No cross-border shortcut. |
| Prescription drugs | Yes, conditionally | Valid electronic prescription from a licensed physician, real-name buyer, pharmacist review, one prescription used once | Vaccines, narcotics, psychotropics and several other classes stay off-limits online. Direct-to-consumer promotion is not permitted. |
| Medical devices | Yes, by class | Product registration or filing, plus an online medical device sales notification; Class III needs an operating licence | Registration timelines for Class II and III are long. Budget in quarters, not weeks. |
| Health supplements | Yes | Either a “blue hat” registration or filing for general trade, or the cross-border retail import route | Cross-border avoids the blue hat but forbids any health function claim in your listing and content. |
The May 2026 move was the clearest signal in years. On 27 May 2026 the National Medical Products Administration issued compliance guidelines on online prescription drug sales, nine months after the draft went out for public comment. The main points, as reported by Sixth Tone: buyers must be identified by real name and ID before a prescription drug order goes through, artificial intelligence cannot be used to review, approve or renew a prescription, the same prescription code cannot be reused for repeat purchases, and platforms must audit their merchants, monitor listings and report violations. Platforms are also barred from pushing consumers to buy drugs for non-treatment purposes through short video or livestream promotion.
These guidelines are not a new law. They make the existing drug administration law easier to enforce, which in practice means more takedowns and faster ones. If your China plan assumed a livestream host talking about a prescription product, delete it.
Where the prescription comes from: internet hospitals
An online prescription drug sale needs a prescription that exists before the sale. That is what internet hospitals produce. A patient opens a consultation in an app, a licensed physician reviews the case, and an electronic prescription is issued, in most provinces for a follow-up rather than a first diagnosis. The prescription then travels to a pharmacy that can dispense it.
The plumbing behind this is now national. The state medical insurance electronic prescription centre covers all 31 provinces and had connected 70,600 designated medical institutions and 271,400 designated retail pharmacies by the end of April 2025 (National Healthcare Security Administration, relayed by the Beijing municipal government). A prescription written in one hospital can be filled in a pharmacy that never saw the patient. That is the single change that made the online prescription channel real, and it is also what pulled prescription volume away from hospital dispensaries into retail, a shift we already covered when looking at the hospital market and at the rise of online healthcare consultation run by the big platforms.
Insurance money is slowly moving online
For years the online channel was cash only. That is changing, city by city. Twelve provinces had opened online settlement of medical insurance electronic prescriptions using the insurance QR code as of early 2025, and 146 pooling areas across 17 provinces had activated the “insurance wallet” for family sharing. In Guangzhou, 682 designated retail pharmacies were connected to online personal-account payment by the end of July 2025, covering Meituan, Ele.me and JD.
The central plan is public: the National Healthcare Security Administration said in January 2026 it aims to build a convenient payment system in about three years, with first-batch cities in 2026, province-wide coverage in 2027 and full rollout at eligible designated institutions in 2028. So the honest answer for a brand today is that insurance-paid online purchase exists, works well in some cities, and does not exist in others. I have seen figures circulating that put coverage at “more than 120 cities”. I could not confirm that number against an official source, so I am not going to repeat it as fact.
Why this matters commercially: when a product can be paid from the insurance personal account, the buyer stops comparing prices and starts comparing your product to nothing at all.
The platforms that matter
Three groups control most of the volume, and they do not work the same way.
JD Health is the volume leader and mostly self-operated, which means it buys stock and controls the supply chain. It reported 35.3 billion yuan of revenue in the first half of 2025, up 24.5% year on year, more than 200 million annual active users, and over 500,000 daily consultations. For a foreign brand, self-operated means slower onboarding and harder margin talks, but far fewer counterfeit problems.
Alibaba Health runs both a self-operated business and a marketplace. Its financial year to March 2025 closed at 30.6 billion yuan of revenue, up 13.2%, with the platform business growing much faster than the self-operated one, up 54%. It sits next to Tmall, so a brand that already runs a store can extend into the health category rather than start from zero. Setting up correctly matters here, and the mechanics are the same as when you open a Tmall store.
Meituan changed the game with instant retail. Pharmacy instant retail, drugs plus non-drug products, reached about 48.7 billion yuan in 2024, up 31.3% year on year according to Menet data cited by 21st Century Business Herald. Meituan launched its instant retail brand Meituan Shangou in April 2025 with a 30-minute delivery promise, and its medicine business had passed 300 million cumulative users by August 2024. Meituan does not replace Tmall or JD. It captures a different moment: the 11pm fever, the allergy attack, the traveller who forgot a box at home. Nobody browses on Meituan. They search a symptom or a product name and buy in ninety seconds.
That last point has a marketing consequence most brands miss. On instant retail, your competitor is whichever box the nearest pharmacy happens to stock. Distribution density beats brand preference. If your product is not physically in the local drugstore’s inventory, no amount of advertising will show it in the app.
What actually builds demand for a health brand in 2026
You cannot advertise a regulated health product the way you advertise a face cream. Claims are restricted, comparative advertising is restricted, and platform review teams remove listings first and discuss later. So demand has to be built around context instead of claims.
Xiaohongshu search. Chinese consumers use Xiaohongshu as a search engine for anything involving the body. They type a symptom, a situation, an ingredient. The mechanism to understand is that Xiaohongshu ranks notes on saves and comments, not on views, and it indexes the note text heavily. So a hundred small honest notes describing situations, written by ordinary users, outrank one polished brand campaign. For a category where you cannot say what your product does, describing when people use it is the legal way to be found.
Generative engine visibility. Chinese buyers now ask DeepSeek, Doubao and Baidu’s AI answers for product shortlists. These models pull from indexed Chinese-language sources: Baijiahao articles, Zhihu answers, industry media, encyclopaedia entries. If your brand has no Chinese-language corpus, the model has nothing to quote and will name a competitor. The fix is unglamorous. Publish factual Chinese content about your ingredient, your origin, your certification, on sites the models actually crawl, and make sure your brand name is spelled the same way everywhere.
WeChat private domain. Health products are repeat purchases, so the cost of the second sale should be near zero. A service account plus group chats run by a real person is how Chinese pharmacy chains do it: refill reminders, seasonal content, direct answers. It is also the only channel you still own if a platform suspends your listing.
KOC and affiliation. Not celebrities. Small accounts, paid on performance, seeded with product. In health, credibility comes from a volume of ordinary voices, not from one loud one.
AI in customer service. Fine for stock, delivery and shipping questions. Not for anything resembling medical guidance, and per the May 2026 guidelines, never for prescription review. Put that line in writing with your Chinese operator.
The category rules are covered in more detail in our guide on marketing for medical, pharmacy and healthcare brands in China, and the import side in our pharmacy and healthcare export guide.
Case study: Eva, a Czech supplement brand
Eva runs export for a Czech company built around mineral water from a spa region, with a magnesium and trace mineral supplement line sold across central Europe. She came to us after eleven months of doing China alone.
The situation was bad but not unusual. They had opened a Tmall Global cross-border store, spent about 420,000 yuan on advertising, and generated roughly 780,000 yuan of sales. Negative unit economics before logistics. Two listings had been pulled because the copy, translated straight from the Czech pack, mentioned immunity support. Under the cross-border route they had no blue hat registration, so no health function claim was allowed at all.
What they had already tried and what failed: Baidu SEM on generic supplement keywords, which brought traffic at a cost per acquisition around 190 yuan for a product priced at 168 yuan; and two Douyin livestreams where the host, correctly briefed not to make claims, had nothing left to say and sold 41 units in four hours.
What we changed, and why. First, we accepted the constraint instead of fighting it: no claims, so no claim-based advertising. We rebuilt discovery around Xiaohongshu search, with content organised by situation rather than by benefit. Sixty-two KOC notes over four months, all built on the spa origin, the water source, the way people in Czech spa towns actually use mineral supplementation. That works because Xiaohongshu users searching health topics are looking for other people’s context, and because the notes rank on saves, which situational content earns and advertising copy does not. Second, we moved repeat purchase into WeChat, with a service account and a small group run by a Chinese-speaking account manager. Third, in parallel, their importer started the blue hat filing so a general trade listing could open later on JD Health.
Fourteen months in, monthly GMV was around 610,000 yuan, repeat purchase rate 31%, and acquisition cost down from about 190 to 74 yuan. Not spectacular. Sustainable, which for a regulated product in China is the harder outcome.
Mistakes that cost the most
Reputation moves fast and forums have long memories. Publish full product information, including side effects and contraindications where the format allows it. Chinese consumers cross-check on search engines before buying anything they will swallow, and a mismatch between your international pack and your Chinese listing gets screenshotted.
Second mistake: assuming platform presence equals visibility. Tmall and JD are trusted, which is why every competitor is there too. A store without a search and content plan is a warehouse nobody visits.
Third: writing the Chinese copy from the European copy. In this category, translation is a compliance risk, not a cost line. Have it written in Chinese by someone who knows what the reviewers reject.
FAQ
Can a foreign pharmaceutical company sell prescription drugs directly to Chinese consumers online?
Not directly. The seller must be a Chinese licensed drug retailer that has filed for online drug sales, and the product must be registered with the NMPA and imported through a licensed channel. On top of that, each prescription drug order needs a valid electronic prescription from a licensed physician, real-name buyer identification, and pharmacist review. Several drug classes remain excluded from online sale altogether. A foreign company enters through a licensed Chinese partner, never as the direct seller.
Do we need a Chinese entity to open a store on JD Health or Tmall Health?
For general trade listings of drugs, devices or blue-hat supplements, yes, in practice you need a Chinese entity or a licensed Chinese distributor holding the registrations. The cross-border retail import route lets a foreign company sell on Tmall Global without a Chinese entity, but only for eligible product categories, and it comes with the claim restrictions described above. Which route fits depends on your product classification, so get that classification confirmed before you budget anything.
Can supplements skip the blue hat registration by going cross-border?
Cross-border retail import does let you sell without a blue hat, and it is the fastest way to test the market. The trade-off is real: you cannot state any health function in your listing, your images, or your influencer briefs, and enforcement of that rule has been getting stricter. Many brands run cross-border for eighteen to twenty-four months while the domestic filing progresses, then switch. Treat cross-border as a test channel, not a permanent model.
Can we promote medicine through Douyin livestreams or short video?
For prescription drugs, no. The May 2026 guidelines specifically bar platforms from pushing consumers toward drug purchases for non-treatment purposes via short video and livestream. For OTC drugs and devices, promotion is possible but the advertising approval rules for medical products apply, and platforms enforce them harder than the law requires because they carry the liability. Plan short video for brand and education, not for direct selling of anything regulated.
Working with GMA on a regulated health product
We handle the marketing side of health and pharmacy launches in China: store setup on Tmall Health, JD Health and instant retail, Xiaohongshu search and KOC programmes written to pass platform review, and Chinese-language content built so AI search engines can quote you.
We work with the licence holders, we do not replace them. If your product cannot legally be sold the way you planned, we say so before the budget is spent.
Tell us what your product is and which route you are considering. Contact our team, or read more about our China e-commerce services.
